Cochrane · intervention · CD004714
Treatment of periodontitis for glycaemic control in people with diabetes mellitus
Simpson, TC, Clarkson, JE, Worthington, HV, et al. · Cochrane Database of Systematic Reviews · 2022 · Cochrane Library
Full textEvery question was extracted from the full review (methods and results), not only its Summary of Findings table.
Questions
10
current version
GRADE rated
1
No studies
2
Included studies
35
as reported
No studies 2 · 20%Ungraded 7 · 70%Very low 0 · 0%Low 0 · 0%Moderate 1 · 10%High 0 · 0%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Review question
| Element | Planned (methods) | Found (results) |
|---|---|---|
| Population | People with diabetes mellitus (type 1 or type 2) and periodontitis, at least 16 years of age; periodontitis accepted on trialist statement (including chronic/adult periodontitis); excluded if >10% gestational diabetes or metabolic syndrome | 35 studies, 3249 randomised participants; almost all Type 2 DM (one study Type 1 or 2); mixed good/fair/poor metabolic control; mostly secondary care; follow-up 3-12 months |
| Intervention | Subgingival instrumentation (scaling and root planing / mechanical debridement); optionally with surgical periodontitis treatment (flap surgery/gingivectomy), antimicrobial therapy (local or systemic), other drug therapy, other novel interventions, supragingival scaling (PMPR), oral hygiene instruction/education | Subgingival instrumentation (20 studies); subgingival instrumentation plus antimicrobials (11 studies); subgingival instrumentation plus antimicrobial mouthrinse (3 studies) |
| Comparison | No (or delayed) treatment or usual care (oral hygiene instruction or supragingival scaling with or without OHI) | No active intervention/usual care (oral hygiene instruction, support, and/or supragingival plaque removal) |
| Outcomes | Primary: glycaemic control measured by HbA1c (% or mmol/mol). Secondary: clinical attachment level; probing pocket depth; bleeding on probing; gingival indices; plaque indices; adverse effects; quality of life (e.g. OHIP-14); diabetic complications; cost implications | HbA1c (n=2443, 30 studies at 3-4mo; n=1457, 12 studies at 6mo; n=264, 1 study at 12mo); CAL (18 studies); PPD (21 studies); BOP (14 studies); PI (18 studies, SMD); GI (12 studies, SMD); adverse effects (narrative); quality of life (3 studies); cost/diabetic complications (no included-study data) |
| Study designs | Randomised controlled trials (RCTs); excluded split-mouth and cross-over; follow-up >=90 days | RCT, parallel group (n=35) |
| Timing | At least 3 months (90 days) after completion of treatment course | 3-4 months; 6 months; 12 months |
Search date: 2021-09. Databases: Cochrane Oral Health's Trials Register; Cochrane Central Register of Controlled Trials (CENTRAL); MEDLINE Ovid; Embase Ovid; CINAHL EBSCO; LILACS BIREME; Web of Science (conference proceedings); ZETOC (conference proceedings); ClinicalTrials.gov; WHO ICTRP
Questions and results
Show all 4 versionsPeriodontal treatment (subgingival instrumentation, with or without antimicrobials/surgery) vs No active intervention/usual care
Population: People with diabetes mellitus (type 1 or type 2, mostly type 2) and periodontitis, at least 16 years of age
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Quality of life indicators 3-4 months | Three studies measured QoL. Vergnes 2018: overall GOHAI adjusted MD 7.0 (95% CI 2.4 to 11.6), 79 participants (better oral health-related QoL); no clear change in general SF-36 QoL. D'Aiuto 2018 ADDQoL better in… | 3 studies | Ungraded |
Bleeding on probing (BOP) 3-4 months | MD -15.56 [-21.77, -9.36] -15.56 [-21.77, -9.36] percentage of sites | 14 studies | Ungraded |
Probing pocket depth (PPD/PD) 3-4 months | MD -0.56 [-0.72, -0.40] -0.56 [-0.72, -0.40] mm | 21 studies | Ungraded |
Gingival index (GI) 3-4 months | SMD -1.75 [-2.27, -1.24] -1.75 [-2.27, -1.24] standard deviations | 12 studies | Ungraded |
HbA1c (glycated haemoglobin), change 3-4 months | MD -0.43 [-0.59, -0.28] -0.43 [-0.59, -0.28] % HbA1c (percentage points) | 30 studies · 2443 participants | Moderate Downgraded: risk of bias |
Plaque index (PI) / oral hygiene 3-4 months | SMD -2.05 [-2.57, -1.53] -2.05 [-2.57, -1.53] standard deviations | 18 studies | Ungraded |
Diabetic complications 3-4 months | Included studies did not report data on diabetic complications (some reported medication changes only) | 0 studies | No studies |
Adverse effects of treatment 3-4 months | SoF comment: insufficient evidence to determine whether SRP for glycaemic control is associated with any harms; most studies did not evaluate adverse effects. Where reported (e.g. D'Aiuto 2018) serious adverse events… | NR | Ungraded |
Clinical attachment level (CAL) 3-4 months | MD -0.48 [-0.65, -0.31] -0.48 [-0.65, -0.31] mm | 18 studies | Ungraded |
Cost implications 3-4 months | Included studies did not report cost data. A brief economic commentary drew on four external economic evaluations (Smits 2020, Nasseh 2017, Choi 2020, Soloweij-Wedderburn 2017) suggesting potential cost… | 0 studies | No studies |